The advent of anti-retroviral nnedications, introduction of highly active anti-retroviral therapy (HAART), and advances in treatment options have transformed HIV disease from an acute terminal disease to a chronic manageable disease. These life-extending treatments can reduce the morbidity and mortality associated with the disease among persons living with HIV/AIDS (PLWHA). Engagement in care is vital for HIV treatment success at both the individual and population levels.^ Although financial barriers to seeking HIV care have been reduced through mechanisms such as the Ryan White Act, a large subset of PLWHA does not remain in 1 2 care. Identifying personal, organizational, and environmental factors that influence patterns of utilization of HIV care among PLWHA is critical to developing strategies to increase initiation of care among them, those who are not in care and retention, and those who have episodic patterns of care utilization. The goal of the HIV care research project is to work with a local community to identify and document psychosocial, cultural, and structural barriers that deter PLWHA in a rural, majority African-American, southern South Carolina (SC) county from initiating and continuing HIV care. Findings of this study will inform development of a pilot, community-initiated intervention to improve initiation and continuation of HIV care among PLWHA.